Journal of critical care
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Journal of critical care · Sep 1993
Postreperfusion syndrome: hypotension after reperfusion of the transplanted liver.
Sixty-nine patients undergoing liver transplantation were evaluated to elucidate the relationship between hypotension and physiological changes seen on reperfusion of the grafted liver. Measured variables included hemodynamic profiles, core temperature, serum potassium, ionized calcium levels, arterial blood-gas tensions, and acid-base state. Measurements were taken 60 minutes after skin incision (baseline), 5 minutes before reperfusion, and 30 seconds and 5 minutes after reperfusion. ⋯ Collectively in both groups, there was no correlation between MAP and physiological variables; however, there was a poor correlation with SVR (r = .32, P < .01). Reperfusion hypotension seen in group 2 patients correlated only with a decrease in systemic vascular resistance (r = .5, P < .05). Acute hyperkalemia, hypothermia, and acidosis do not appear to be major causes of reperfusion hypotension.
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Journal of critical care · Sep 1993
Infusion of ultrafiltrate from endotoxemic pigs depresses myocardial performance in normal pigs.
We previously showed a beneficial effect of hemofiltration on hemodynamics of endotoxic shock pigs. To test the hypothesis that this effect of hemofiltration is caused by convective removal of factors that adversely affect hemodynamics during endotoxemia, we infused ultrafiltrate from endotoxic shock pigs into healthy pigs. Their hemodynamics were compared with those of pigs who were infused with ultrafiltrate from healthy pigs. ⋯ The decrease in cardiac output in group 1 was greater than in group 2 (3.3 +/- 0.2 L/min v 0.3 +/- 0.3 L/min, P < .02) and was due to a decrease in stroke volume. The decrease in right ventricular ejection fraction was also greater (0.15 +/- 0.02 v 0.01 +/- 0.00, P < .01). Systemic vascular resistance, right atrial pressure, right ventricular end-diastolic volume, pulmonary wedge pressure and heart rate did not differ between groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Journal of critical care · Jun 1993
Stressing the critically ill patient: the cardiopulmonary and metabolic responses to an acute increase in oxygen consumption.
Critically ill patients frequently have compromised respiratory and hemodynamic function. Chest physical therapy has been previously shown to increase oxygen demand and therefore was used to examine how postoperative mechanically ventilated patients responded to an increased oxygen demand. We found that during chest physical therapy, oxygen consumption increased 52% +/- 37% (SD) over baseline values. ⋯ There was no significant change in systemic vascular resistance. The increase in oxygen demand caused by chest physical therapy triggered an integrated physiological response that resulted in increased respiratory and cardiac performance. This in some ways, such as the lack of increase in systemic vascular resistance, resembles the response to exercise.
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Journal of critical care · Jun 1993
Comparative StudyOrgan blood flow and distribution of cardiac output in dopexamine- or dobutamine-treated endotoxemic rats.
Endotoxemia causes a decrease of blood flow to most organs. If this could be prevented, chances of survival might improve. In endotoxemic rats, we studied the effect of a therapeutic infusion of dopexamine (dopaminergic, beta 2-adrenergic) on blood flow and percentage of the cardiac output distributed to heart, brain, hepatic artery, stomach, intestines, spleen, pancreas, kidneys, adrenals, diaphragm, skeletal muscle, and skin. ⋯ Dopexamine and dobutamine similarly improved cardiac output in endotoxemic rats. All organs benefitted to the same extent from the increased cardiac output. Therapeutic infusion of dopexamine during endotoxemia did not favor flow to any particular organ; redistribution of cardiac output changed little after administration of dopexamine, and its effects were not significantly different from those of dobutamine.
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Journal of critical care · Jun 1993
Allocation of critical care resources: entitlements, responsibilities, and benefits.
Determination of allocation of limited critical care resources appears to be an inevitable development. Criteria proposed to assign such limited resources among patients are not defined. It has been argued that allocation of critical care resources could be based on the principals of patient entitlements to health care, responsibilities of the physician to the critically ill patient, and beneficence. However, based on an analysis of the philosophical tenants of the Hippocratic Oath, there is little to support the concept of "sin" taxes or patient triage on the basis of judgment on the moral merit of the patient.